Healthcare Provider Details

I. General information

NPI: 1528979697
Provider Name (Legal Business Name): YVETTE LEE ELLSWORTH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ORCHARD ST
BELDING MI
48809-9277
US

IV. Provider business mailing address

8825 YOUNG AVE NE
ROCKFORD MI
49341-9321
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-4774
  • Fax:
Mailing address:
  • Phone: 616-915-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: